The politics of health care are scary and strange but there are also positive possibilities for broadening coverage.

What hurts patients and providers, such as the sabotage of the Affordable Care Act pursued by President Donald Trump, needs to be countered and corrected. Expanding Medicaid is one way to do this.

One kind of Trumpian damage involves trying to harm the ACA market many Americans use to choose a health care plan by refusing to pay insurance companies the cost-sharing reduction payments, also known as CSRs.

As if to clarify Trump’s motive, his former White House advisor, the alt-right figure Steve Bannon openly bragged at a conservative event, “Not gonna make the CSR [cost-sharing reduction] payments, gonna blow that thing up, gonna blow those [insurance] exchanges up, right?”

Second, Trump also cuts support for helping people learn when and how to sign up for health coverage under the ACA. There’s now a shorter time period for citizens to choose a policy and the healthcare.gov website will be shut down for maintenance for 12 hours every Sunday. It’s predictable that more people who need coverage will miss the window to sign up.

President Donald Trump signed an executive order to make it easier for Americans to buy bare-bones health insurance plans at the White House on Oct. 12. REUTERS/Kevin Lamarque TPX

Third, Trump signed executive orders that will undermine the health insurance system by bringing back plans with skimpy coverage. People who need medicine, scans, physical and mental therapy and surgery won’t buy these low-quality plans. This will drive up the cost of better plans, creating a death spiral for health insurance markets and making people who bought the new plans vulnerable to bankruptcy if they get in an accident or contract a serious malady like cancer.

As Sen. Susan Collins summarized the sabotage in a Sunday CNN interview, “So these certainly are very disruptive moves that will result in smaller numbers of people being insured, that will make it more difficult for low-income people to afford their out-of-pocket costs, and that will destabilise the insurance markets.”

Fighting against those who want to blow up health coverage will take many forms. Around the country, state attorneys generals, including Maine Attorney General Janet Mills, are filing or involved in lawsuits against the many ways Trump is trying to hobble health care coverage.

Congress could act by including subsidies in the federal budget. That’s what strong majorities want, along with support for people signing up for health care policies.

This summer people organized and spoke out against terrible health care bills and their voices mattered. Sens. Angus King and Collins voted against these, as did Rep. Chellie Pingree, while Rep. Bruce Poliquin voted for a bill that would have led to 23 million fewer people having coverage even while cutting taxes for very wealthy people. Poliquin also voted for a tax bill that, according to The Hill, “includes plans for trillions of dollars in spending cuts over a decade, including from programs such as Medicare and Medicaid.”

We should also tell people who need coverage that the ACA signup period is a lot shorter this year — just from Nov. 1 to Dec. 15. A group called Get America Covered is trying to spread the word and has fact sheets and other help.

Covering everyone is the political issue of the future. According to a September Kaiser Health Tracking Poll, two-thirds of Americans support letting people buy into Medicaid; allowing young people to purchase insurance is backed by 63 percent and single-payer by 54 percent.

Now Mainers have two opportunities to improve health coverage.

One is to vote for Medicaid expansion on Nov. 7 to deliver better care and coverage to low-income working people and to help rural hospitals.

Another is to put another health issue on the ballot. Petitioners will be at the polls to collect signatures for a referendum for in-home care for elderly and disabled people, which is far cheaper than nursing homes and also what those who need this care prefer.

Passing Medicaid expansion will send a message heard nationally that people want more and better health care, not sabotage that hurts patients, providers and communities.

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About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.

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Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.